Attachment M

Draft document, "Volunteer's Participation Agreement Form,"
Chemical Corps Medical Laboratories at the Army Medical Center in
Maryland (undated)

DRAFT

CHEMICAL CORPS MEDICAL LABORATORIES
ARMY CHEMICAL CENTER, MARYLAND

FORM 1 - Volunteer's Participation Agreement
NAME
AGE, Race Grade Serial No.
Organization
Name of Nearest Relative
Address of Nearest Relative
Telephone Number of Nearest Relative
I, , certify that the nature of the experiment I have volunteered
to participate in has been explained fully from the standpoint of
possible hazards to my health. I certify that I have been
familiarized with the nature of the experiment and the agents to
be used, commensurate with security requirements. It is my
understanding that the experiment is so designed and based on the
results of animal experimentation of the natural history of the
disease or other problems under study that the anticipated
results will justify the performance of the experiment. I
understand further that the experiment will be so conducted as to
avoid all unnecessary physical and mental suffering and injury,
and that I will be at liberty to request that the experiment be
terminated if in my opinion I have reached the physical or mental
state where continuation of the experiment becomes impossible.

I recognize that in the pursuit of certain experiments transitory
mental disturbance or unconsciousness may occur and when such
reactions seem especially likely to occur I will be so advised. I
recognize, also, that under these circumstances, I must rely upon
the skill and wisdom of the physician supervising the experiment
to institute whatever medical or surgical measures are indicated
to protect me against the possibility of serious or permanent
injury and/or disability, or death.

I certify that there has been no coercion, element of fraud or
deceit, undue moral suasion or other adverse pressure brought to
bear in my volunteering for this study. I have done so of my own
free will, completely aware of all hazards, rewards and
recognition involved.

DATE: WITNESS:

SIGNED: WITNESS: